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New Standards for Safety

New Standards for Safety. ©2006. Retractable Technologies, Inc. BACKGROUND. 600,000 to 800,000 needlestick injuries are reported each year in the U.S. Approximately half of all injuries are unreported.

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New Standards for Safety

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  1. New Standards for Safety ©2006. Retractable Technologies, Inc.

  2. BACKGROUND • 600,000 to 800,000 needlestick injuries are reported each year in the U.S. • Approximately half of all injuries are unreported. • Needlesticks are the cause of 80% to 90% of the occupational transmissions of infectious disease. • At least 1,000 healthcare workers are estimated to contract serious infections annually from needlesticks and sharps injuries.

  3. Nurses account for 40% of reported exposures.

  4. Malaria Cytomegolovirus Over 23 bloodborne pathogens can be transmitted by needlestick injuries. Herpes Simplex Babesiosis HTLV –Associated Myelophothy Toxoplasmosis Tetanus Staphylococcus Brucellosis Streptococcus Tuberculosis Blastomycosis Diphtheria Syphilis Epstein-Barr Virus Typhus Ebola Rocky Mountain Spotted Fever

  5. RISKS OF NEEDLESTICK INJURIES • The most frequent and serious: • Hepatitis B • Hepatitis C • HIV

  6. HBV • The CDC estimates that 1.25 million Americans are chronically infected with hepatitis B virus (HBV). • Immunization of healthcare workers with hepatitis B vaccine has led to a decline in new infections. • As a result of immunization, cases of HBV in health care workers dropped from 17,000 annually (1983) to 400 annually (1995) –and continue to drop. • The seroconversion rate of HBV following a needlestick injury ranges from 6% to 30%.

  7. HCV • Hepatitis C virus (HCV) affects approximately 4 million people in the U.S. making it the most common chronic bloodborne infection. • HCV is the most frequent infection resulting from needlestick and sharps injuries. • There is no available vaccine against HCV. • The seroconversion rate to HCV averages 1.8% (range extends as high as 7%) per injury.

  8. HIV • Percutaneous injuries were associated with 89% of documented HIV transmissions. • The average seroconversion rate of HIV is 0.3% per injury, however “high-risk” needlestick injuries carry greater risk of disease transmission. • At the end of 2003, an estimated 1,039,000 to 1,185,000 persons in the US were living with HIV/AIDS, with 24-27% undiagnosed and unaware of their HIV infection. • The CDC estimates that approximately 40,000 persons in the US become infected with HIV each year.

  9. UNAIDS

  10. Needlestick Victims • Lynda Arnold • RN for 4 months • Stuck while starting an IV • Tested positive for HIV after 6 months • Karen Daly • RN for more than 20 years • Stuck while disposing sharp • Tested positive for HIV and HCV after 5 months

  11. What do I do if I get a needlestick? • Wash wound with soap and water • Alert your supervisor/instructor and initiate the injury reporting system • If possible, identify the source patient, who may need to be tested • Report to employee health, ER, or other designated treatment facility • When source is unknown or tests positive, get post exposure prophylaxis (PEP) in accordance with CDC guidelines. If patient has HIV, start prophylaxis within two hours of exposure. • Get baseline testing for HIV, hepatitis B, and hepatitis C • Document the exposure • Follow-up testing at 6 weeks, three months, and six months, and depending on the risk, at one year.

  12. PREVENTION is the key!

  13. Legislation

  14. Occupational Safety and Health AdministrationOSHA Who is covered by OSHA? • OSHA protects employees who may be occupationally exposed to blood and other potentially infectious materials (OPIM), which includes but is not limited to: • Physicians • Nurses • Phlebotomists • Emergency Medical Personnel • Operating Room Personnel • Laundry Workers • Other Health Care Workers

  15. Federal OSHA Bloodborne Pathogens Standard • Issued in 1991 • revised April 18, 2001 as a result of the Needlestick Safety and Prevention Act signed in 2000 by President Clinton) • Requires compliance with standard precautions • Prohibits bending, breaking, recapping, or removing contaminated needles • Calls for the use of PPE (personal protective equipment) • Mandates free Hepatitis B vaccinations and…

  16. Calls for engineering controls as the primary means to eliminate or minimize worker exposure to bloodborne pathogens

  17. 2001 Revisions to Bloodborne Pathogens Standard • New and expanded definition of “engineering controls” to include safer medical devices • Defines safety devices and needleless systems • Requires that exposure control plans include evaluation of safety devices • Requires that sharps injury logs be kept including the type and brand of device involved in the incident • Requires that employers involve frontlinehealth care workers in the evaluation and selection of safer devices.

  18. What are engineering controls?

  19. Engineering Controls Federal OSHA defines as: Controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps withengineeredsharps injury protection and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace.

  20. To qualify as SESIP the safety feature of a sharp must be: • Built into the device • Meaning the safety features are integral to the design and function of the device and • Effectively reduce the risk of an exposure incident

  21. Characteristics of Safety DevicesNIOSH - Nov 1999 • The device is needleless • The safety feature is an integral part of the device • The device preferably works passively. • If user activation is necessary, the safety feature can be engaged with a single-handed technique and allows the worker’s hands to remain behind the exposed sharp.

  22. Characteristics of Safety DevicesNIOSH - Nov 1999 • The user can easily tell whether the safety feature is activated. • The safety feature cannot be deactivated and remains protective through disposal. • The device performs reliably. • The device is safe and effective for patient care.

  23. ECRI(Emergency Care Research Institute) • Conducts impartial evaluations of biomedical technology • Set new criteria for safety products: • safety mechanism should be activated before the needle is removed from the patient

  24. Studies show that the majority of needlestick injuries occur within seconds after a needle is removed from a patient.

  25. Syringes and Needles

  26. Syringe Based –Sheath/Shield Devices • Activated after removal from the patient • Requires two hands to activate BD SafetyLok Monoject Safety Syringe

  27. Needle Based – Recapping Devices • Activated after removal from the patient • Requires a change is hand position • “Activation of the protective mechanism may cause minimal splatter of fluid” (Under BD’s Directions for Use on product box) BD Safety Glide SIMS Portex Needle Pro • Requires a hard surface for activation

  28. Retractable Syringes VanishPoint • Activated in patient using one hand by fully depressing the plunger • Eliminates exposure to the contaminated sharp BD Integra

  29. Websites • www.osha.gov • www.cdc.gov • www.nursingworld.org • www.isips.org • www.tidict.org • www.vanishpoint.com

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